My academic career demonstrates a long-term commitment to patient-oriented research, extensive expertise in the study of the pathophysiology of age related cardiovascular disorders that disproportionately afflict older adults including heart failure with preserved ejection fraction and a successful record in mentoring residents, cardiology fellows and junior faculty in geriatrics and cardiology. My career plan is to expand my research interests to multidisciplinary studies of age related cardiovascular conditions by focusing on: (a) heart failure with a normal ejection fraction, which accounts for more than half of the cases of heart failure in the United States and that afflicts predominately older adults, (b) the emerging phenotype of paradoxically low flow aortic stenosis and (c) TTR cardiac amyloidosis that almost exclusively affects older adults. During the tenure of this award, the applicant will strengthen existing and form new collaborative relationships with basic and clinical investigators at Columbia University and continue a successful mentoring program for young clinical investigators from geriatrics, cardiology and other subspecialty fields of medicine that will foster collaborative interdisciplinary investigations. The latter will be achieved by ongoing development of the Greater New York Geriatric Cardiology Consortium (www.gnygcc.org) aimed at improving the care of older adult patients with cardiovascular disease by performing innovative, investigator initiated, multicenter collaborative clinical investigation. The proposed mentoring program consists of four other components: 1) intensive individualized training in patient oriented research; 2) didactic programs on clinical trial design data analysis, grant writing, and ethics; 3) a group/peer mentoring CoMPAdRE Program (Columbia Mentor Peer Aging Research Program) developmental relationships and 4) critical review by a team of patient oriented research experts and a 360 that will seek to encourage mentees to be the perfect protg and assist them in building a network of evaluation of the PI by mentees and faculty participants. Renewal of this Midcareer Investigator Award in Patient Oriented Research will provide critically needed protected time to achieve these career goals and continuing the mentorship of five current K23 awardees at Columbia University and other mentees at outside institutions and in the pipeline. Columbia provides a strong institutional environment for support of the applicant's career development. The Department of Medicine and Division of Cardiology have committed to protect 50% of the applicant's time for patient oriented research and mentoring. The proposed aims are to evaluate: (1) To determine if the DASH-SR diet post-hospitalization for HF can induce a hedonic shift and alter salt sensitivity in older adults (2) To evaluate whether TTR cardiac amyloid is the cause of the phenotype of HFpEF due to paradoxically low flow aortic stenosis in older adults undergoing TAVR/SAVR, (3) To deploy an online comprehensive geriatric assessment (CGA) instrument and conduct 500 interviews to advance care and improve QOL in older adults with CV disease, (4) To evaluate the utility of a novel measure, the myocardial contraction fraction (MCF) for predicting HFpEF. The proposed studies will advance applicant career development and provide a mechanism by which trainees can acquire the necessary skills to launch a research career and collect data to support grant applications. The ultimate goal is to facilitate the development of a new generation of investigators from both cardiology and geriatrics that can pursue clinical research in the arena of aging cardiovascular disease.